Intravascular imaging for stent planning with simultaneous landing zone adjustment and visualization

Abstract

A system includes a processor circuit configured to control an intravascular imaging catheter to obtain intravascular images while the catheter is moved through a blood vessel of a patient, and output a screen display for stent planning. The screen display includes a visual representation of the blood vessel and a virtual stent overlaid in a first position on the visual representation. The processor circuit receives a first user input to move the virtual stent from the first position to a different, second position on the visual representation, and updates the screen display. The updated screen display includes the visual representation of the blood vessel and the virtual stent overlaid in the second position on the visual representation. The length of the virtual stent is the same in the first position, in the second position, and while the virtual stent moves from the first position to the second position.

Description

INTRAVASCULAR IMAGING FOR STENT PLANNING WITH SIMULTANEOUS LANDING ZONE ADJUSTMENT AND VISUALIZATIONTECHNICAL FIELD

[0001] The present disclosure relates generally to intravascular imaging (e.g., intravascular ultrasound (IVUS), optical coherence tomography (OCT), etc.) using an intravascular imaging catheter for planning a location for placement of an intravascular stent. In particular, a user can move a virtual stent without changing its length, such that the intravascular images at both ends of the virtual stent are simultaneously updated to reflect the current position of the virtual stent.BACKGROUND

[0002] Intravascular imaging (IVI) (such as intravascular ultrasound (IVUS) or optical coherence tomography (OCT) imaging) is widely used in interventional cardiology as a diagnostic tool for assessing a diseased vessel, such as an artery, within the human body to determine the need for treatment, to guide the intervention, and / or to assess its effectiveness. An IVI device including one or more ultrasound transducers is passed into the vessel and guided to the area to be imaged. The transducers emit ultrasonic energy in order to create an image of the vessel of interest. Ultrasonic waves are partially reflected by discontinuities arising from tissue structures (such as the various layers of the vessel wall), red blood cells, and other features of interest. Echoes from the reflected waves are received by the transducer and passed along to an IVI (e.g., IVUS or OCT) imaging system. The imaging system processes the received ultrasound echoes to produce a cross-sectional image of the vessel where the device is placed.

[0003] Peripheral and coronary vascular procedures, such as stenting, often involve IVI. A stent is a dense (e.g., metallic) object that may be placed in a vessel or lumen to hold the vessel or lumen open to a particular diameter, to counteract the effects of an occlusion, plaque, or compression. Pre-treatment decisions, such as whether and where to place a stent, may depend on accurate measurements of the vessel lumen area (and / or other anatomical measurements) across a range of locations within the vessel, made during the procedure itself.

[0004] For example, during the procedure, a physician can use IVI to find diseased segments of the vessel. A physician uses this information to decide what length of stent to place in the vessel to cover the lesion, and where within the vessel to place it. The planned location for stentplacement includes two endpoints: a proximal reference frame or landing zone, and a distal reference frame or landing zone, representing the two ends of the stent.

[0005] Current IVI systems allow the physician to adjust the position of one IVI frame at a time. For example, IVI software allows for users to move one end (e.g., the proximal or distal reference frame) of a segment at a time. This is useful for finding a lesion, and for finding one healthy landing zone at a time. However, stents do not come in all lengths, and may for example be available in 2 mm or 5 mm increments. The user must therefore select locations within the vessel for each landing zone, such that the minimum lumen area occurs between the landing zones, such that the distance between the landing zones is equal to the length of an actual stent currently available in the catheterization lab, and such that the vessel area and / or plaque burden at both landing zones is approximately equal. This places a substantial burden on the user, in the midst of an intravascular the procedure, when time is of the essence.

[0006] Thus, a need exists for improved stent planning devices, systems, and methods, that address the foregoing and other concerns.

[0007] The information included in this Background section of the specification, including any references cited herein and any description or discussion thereof, is included for technical reference purposes only and is not to be regarded as subject matter by which the scope of the disclosure is to be bound.SUMMARY

[0008] Stent placement planning systems, devices, and methods are provided for intravascular imaging (e.g., intravascular ultrasound or IVUS, optical coherence tomography or OCT, etc.). The stent placement planning system allows a user to place and move a virtual stent without changing its length in extraluminal / extravascular view of the vessel (e.g., a 2D image, such as an angiographic x-ray image, a 3D model, etc.) and / or a longitudinal view of the vessel (e.g., an in-line digital or image longitudinal display (ILD)). The system includes a software feature that helps the operator to plan the landing zones for a stent with a standard / commercially available length. Based on a user input, the stent placement planning system can simultaneously translate both the proximal and distal reference frames or landing zones (the proximal and distal ends of the virtual stent), such that movement of one reference frame or landing zone corresponds to an equal movement of the other reference frame or landing zone. This has the effect of moving the entire virtual stent (both the proximal and distal reference frames / landing zones) along the vessel in a proximal or distal direction. The intravascular images at the proximal and distal reference frames or landing zones are simultaneously updated to reflect the views at the current location of the proximal and distal ends of the stent end. The user can move the virtual stent to a desirable location. The stent placement planning system has particular but not exclusive utility for intravascular imaging of blood vessels with impeded blood flow (blocked by plaque, compressed by other anatomy, etc.) before stenting, to determine the size of stent to be used and the location where the stent will be placed.

[0009] This Summary is provided to introduce a selection of concepts in a simplified form that are further described below in the Detailed Description. This Summary is not intended to identify key features or essential features of the claimed subject matter, nor is it intended to limit the scope of the claimed subject matter. A more extensive presentation of features, details, utilities, and advantages of the stent placement planning system, as defined in the claims, is provided in the following written description of various aspects of the disclosure and illustrated in the accompanying drawings.BRIEF DESCRIPTION OF THE DRAWINGS

[0010] Illustrative aspects of the present disclosure will be described with reference to the accompanying drawings, of which:

[0011] Figure 1 is a diagrammatic schematic view of an intraluminal imaging system, according to aspects of the present disclosure.

[0012] Figure 2 is a schematic diagram of a processor circuit, according to aspects of the present disclosure.

[0013] Figure 3 illustrates a blood vessel incorporating a plaque, according to aspects of the present disclosure.

[0014] Figure 4 illustrates a blood vessel incorporating a plaque and with a stent expanded inside it to restore flow, according to aspects of the present disclosure.

[0015] Figure 5 is a lesion length screen display of an example stent placement planning system, according to aspects of the present disclosure.

[0016] Figure 6 is a stent planning screen display of an example stent placement planning system, according to aspects of the present disclosure.

[0017] Figure 7 is a stent planning screen display of an example stent placement planning system, according to aspects of the present disclosure.

[0018] Figure 8 is a stent planning screen display of an example stent placement planning system, according to aspects of the present disclosure.

[0019] Figure 9 is a stent planning screen display of an example stent placement planning system, according to aspects of the present disclosure.

[0020] Figure 10 is a stent planning screen display of an example stent placement planning system, according to aspects of the present disclosure.

[0021] Figure 11 is a schematic, diagrammatic view, in flow diagram form, of an example stent planning method, according to aspects of the present disclosure.

[0022] Figure 12A is a close-up view of the image longitudinal display (ILD) from Figure 6, according to aspects of the present disclosure.

[0023] Figure 12B is a close-up view of the ILD from Figure 7, according to aspects of the present disclosure.

[0024] Figure 12C is a close-up view of the ILD from Figure 8, according to aspects of the present disclosure.

[0025] Figure 13A is a close-up view of the tomographic image display area from Figure 6, according to aspects of the present disclosure.

[0026] Figure 13B is a close-up view of the tomographic image display area from Figure 7, according to aspects of the present disclosure.

[0027] Figure 13C is a close-up view of the tomographic image display area from Figure 8, according to aspects of the present disclosure.

[0028] Figure 14A is a close-up view of the annotated angiographic image of Figure 6, showing the 15 mm virtual stent in the first position within the blood vessel, according to aspects of the present disclosure.

[0029] Figure 14B is a close-up view of the annotated angiographic image of Figure 7, showing the 15 mm virtual stent being moved within the blood vessel in a distal direction, according to aspects of the present disclosure.

[0030] Figure 14C is a close-up view of the annotated angiographic image of Figure 8, showing the 15 mm virtual stent in the second position within the blood vessel, according to aspects of the present disclosure.

[0031] Figure 15 is a screen display of an example stent placement planning system, according to aspects of the present disclosure.

[0032] Figure 16 is a screen display of an example stent placement planning system, according to aspects of the present disclosure.

[0033] Figure 17 is a screen display of an example stent placement planning system, according to aspects of the present disclosure.

[0034] Figure 18 is a screen display of an example stent placement planning system, according to aspects of the present disclosure.

[0035] Figure 19 is a screen display of an example stent placement planning system, according to aspects of the present disclosure.

[0036] Figure 20 is a screen display of an example stent placement planning system, according to aspects of the present disclosure.

[0037] Figure 21 is a screen display of an example stent placement planning system, according to aspects of the present disclosure.DETAILED DESCRIPTION

[0038] During an intravascular intervention procedure, a physician can use IVI to find diseased segments of the vessel. A physician uses this information to decide what length of stent to place in the vessel to cover the lesion, and where within the vessel to place it. The planned location for stent placement has two landing zones, one for each end of the stent (proximal and distal). To see the intravascular image and data associated with the landing zones for a specific stent length, a physician has to adjust the position of one IVI reference frame at a time.

[0039] In accordance with at least one aspect of the present disclosure, a stent placement planning system is provided which provides simultaneous landing zone adjustment and visualization for stent planning with intravascular imaging. This enables a user to plan both landing zones at the same time, using real stent lengths available in the lab. The stent placement planning system allows the two IVI frames to be a fixed length apart within the software, so that the operator can move both together at the same time while seeing both corresponding IVI frames update simultaneously. This can be deployed as part of automated IVI image interpretation software, or it can work independently of automated image interpretation software.

[0040] The stent placement planning system allows the user to place and move a virtual stent in an extraluminal / extravascular view of the vessel (e.g., a 2D image, such as an angiographic x- ray image, a 3D model, etc.) and / or a longitudinal view of the vessel (e.g., an in-line digital or image longitudinal display (ILD)). A virtual stent can be a graphic, indicator, and / or other visual UI element is that provided on a display. In some instances, the virtual stent has a length matching a commercially available / standard stent length (typically, positive whole number values and / or positive integer values). As described herein, the virtual stent can be displayed in a desired area of a 2D or 3D depiction of vessel, as part of a physician planning the deployment of stent before the actual / real stent is positioned inside the actual / real vessel of the patient. The longitudinal view can be generated based on the intravascular imaging data itself (e.g., an imagebased ILD) or measurements / statistics from the intravascular imaging data (e.g., vessel diameter, lumen diameter, vessel cross-sectional area, lumen cross-sectional area, etc., for a graphical ILD). The stent placement planning system includes a software feature that helps the operator to plan the landing zones of a stent of a given length. The feature allows the user use to move the representation of the stent or region to be covered by the stent within the software, and simultaneously see both intravascular imaging frames corresponding to the landing zones.

[0041] When a diseased segment is identified within a vessel by an IVI image interpretation system, generally, three image frames may be identified: a proximal reference frame, a minimum lumen area frame, and a distal reference frame. In some cases, the proximal and distal reference frames can be used as landing zones for the proximal and distal ends of a stent. However, in the more general case, these frames are separated by a non-integer distance that does not correspond to the length of real stents.

[0042] Therefore, the stent placement planning system enables the user to re-size the segment by either moving the proximal or distal reference frame location in a proximal or distal direction, or otherwise setting a desired length for the segment. If the re-sized segment has a length that matches the standard length of an available stent, the segment may then be considered a virtual stent. In that regard, the segment of interest can be different than / distinct from the virtual stent because the segment of interest has a decimal value of length (e.g., 11.3 mm or 11.35 mm) that does not match a commercially available / standard stent length (e.g., 12 mm). Based on user inputs, the stent placement planning system can then translate the proximal and distal reference frames or landing zones simultaneously, such that movement of one reference frame or landing zone produces an equal movement of the other reference frame or landing zone. This has the effect of moving the virtual stent along the vessel in a proximal or distal direction. The user can then move the virtual stent to a desirable location such that, for example, the proximal and distal ends of the virtual stent fall in regions of approximately equal lumen area or plaque burden. If no acceptable location can be identified that meets these criteria, the user can optionally resize the virtual stent to a larger or smaller length.

[0043] The stent placement planning system includes a user interface (UI) capable of touch input or click input on an IVI ILD of a vessel (e.g., and IVUS or OCT image longitudinal display), or on an associated angiography X-ray image of the vessel, to select and move the endpoints of a diseased segment to create a virtual stent, and to move the virtual stent along the vessel to a desired location.

[0044] In a non-limiting example, if the physician or software finds a lesion to be 16.4mm in length, the physician may select an 18mm stent to fully cover the lesion. The stent placement planning system helps the physician plan the placement of that 18mm stent. In currently available software, the user can adjust one end of that 16.4mm segment at a time. If the user wants to see both landing zones, they can extend one end of that 16.4mm segment so that it is18mm. With such systems, the two landing zones are the correct length apart, but the position is not optimized. If the user wants to move the position of the segment in software to be more proximal or more distal, then the two ends of the segment need to be adjusted individually.

[0045] With the stent placement planning system, the segment can represent an 18mm stent, and the whole segment can move more proximal or more distal. Doing so allows the user to see both landing zones (e.g., both ends of that segment) at the same time, helping the user to find the safest location to place the landing zones for the stent.

[0046] The stent placement planning system includes a visual representation of a segment of interest within a recorded IVI pullback, with a proximal and distal end, in the software. For example, this may be a visual representation of a lesion, the span of a lesion, or a stent.

[0047] When using the stent placement planning system, the initial length of the segment of interest can be known or pre-determined. This may for example include IVI pullback data with known length between the recorded frames (meaning if two IVI frames were recorded at some distance apart in the vessel, the system can know or determine what that distance is). The length could have been measured (e.g., with a pullback motor encoder), calculated, or estimated.

[0048] Examples of calculation or estimation of pullback speed can be found for example in U.S. Application No. 16 / 542,001, filed August 15, 2019, and U.S. Application No. 16 / 662,847, filed October 24, 2019, incorporated by reference as though fully set forth herein.

[0049] The stent placement planning system allows the user to set the length of the segment of interest to be the length of a stent. This can be done either by entering the length into the system, or adjusting one end of the segment of interest until it is the correct length.

[0050] The user can also interact with the software to move the entire segment of interest within more proximal or more distal within the recorded IVI pullback, without changing the length of the segment. Rather, the stent placement planning system allows the user to move the entire segment of interest in unison, such that both ends of the segment of interest move together, and the display of IVI frames showing the proximal and distal ends of the segment of interest are updated in real time.

[0051] The stent placement planning system is well-suited to be part of any IVI interpretation software where two ends of a segment can be manipulated independently. The stent placement planning system includes software to be that ties the two ends of a segment together with a fixed length. This is useful for planning the landing zones of a stent.

[0052] The devices, systems, and methods described herein can include one or more features described in U.S. Provisional App. No. 63 / 600,110, filed November 17, 2023, which is hereby incorporated by reference in its entirety as though fully set forth herein.

[0053] The devices, systems, and methods described herein can include one or more features described in U.S. Provisional App. No. 62 / 750,983, filed 26 October 2018, U.S. Provisional App. No. 62 / 751,268, filed 26 October 2018, U.S. Provisional App. No. 62 / 751,289, filed 26 October 2018, U.S. Provisional App. No. 62 / 750,996, filed 26 October 2018, U.S. Provisional App. No. 62 / 751,167, filed 26 October 2018, and U.S. Provisional App. No. 62 / 751,185, filed 26 October 2018, each of which is hereby incorporated by reference in its entirety as though fully set forth herein.

[0054] The devices, systems, and methods described herein can also include one or more features described in U.S. Provisional App. No. 62 / 642,847, filed March 14, 2018, U.S. Provisional App. No. 62 / 712,009, filed July 30, 2018, U.S. Provisional App. No. 62 / 711,927, filed July 30, 2018, and U.S. Provisional App. No. 62 / 643,366, filed March 15, 2018, each of which is hereby incorporated by reference in its entirety as though fully set forth herein.

[0055] The stent placement planning system has particular but not exclusive utility for ultrasound imaging of occluded blood vessels before stenting, to determine the size of stent to be used and the location where the stent will be placed.

[0056] The present disclosure aids substantially in the real-time planning of stent placement during an interventional intravascular procedure, by allowing the user to create and move a virtual stent within the vessel. Implemented on an IVI console in communication with an IVI catheter or IVI guidewire in communication with a processor such as a patient interface module (PIM), the stent placement planning system disclosed herein provides practical improvements in the treatment of vascular diseases. This improved stent placement planning technique transforms a largely manual process that is dependent on expertise, dexterity, and time into one that can be performed repeatably at high speed, without the normally routine need for extensive training of clinicians. This unconventional approach improves the functioning of the ultrasound imaging system, by streamlining the process by which stent sizes and landing zones are selected.

[0057] The stent placement planning system may be implemented as a process at least partially viewable on a display, and operated by a control process executing on a processor that accepts user inputs from a keyboard, mouse, touchscreen interface, or other user interface, andthat is in communication with an intraluminal (e.g., intravascular) imaging device. In that regard, the control process performs certain specific operations in response to different inputs or selections made at different times. Certain outputs of the stent placement planning system may be printed, shown on a display, or otherwise communicated to human operators. Certain structures, functions, and operations of the processor, display, sensors, and user input systems are known in the art, while others are recited herein to enable novel features or aspects of the present disclosure with particularity.

[0058] These descriptions are provided for exemplary purposes only, and should not be considered to limit the scope of the stent placement planning system. Certain features may be added, removed, or modified without departing from the spirit of the claimed subject matter.

[0059] For the purposes of promoting an understanding of the principles of the present disclosure, reference will now be made to the aspects illustrated in the drawings, and specific language will be used to describe the same. It is nevertheless understood that no limitation to the scope of the disclosure is intended. Any alterations and further modifications to the described devices, systems, and methods, and any further application of the principles of the present disclosure are fully contemplated and included within the present disclosure as would normally occur to one skilled in the art to which the disclosure relates. In particular, it is fully contemplated that the features, components, and / or steps described with respect to one aspect may be combined with the features, components, and / or steps described with respect to other aspects of the present disclosure. For the sake of brevity, however, the numerous iterations of these combinations will not be described separately.

[0060] Figure 1 is a diagrammatic schematic view of an intraluminal imaging system, according to aspects of the present disclosure. The intraluminal imaging system 100 can be an intravascular ultrasound (IVUS) imaging system in some aspects. The intraluminal imaging system 100 may include an intraluminal device 102, a patient interface module (PIM) 104, a console or processing system 106, a monitor 108, and an external imaging system 132 which may include angiography, ultrasound, X-ray, computed tomography (CT), magnetic resonance imaging (MRI), or other imaging technologies, equipment, and methods. The intraluminal device 102 is sized and shaped, and / or otherwise structurally arranged to be positioned within a body lumen of a patient. For example, the intraluminal device 102 can be a catheter, guide wire, guide catheter, pressure wire, and / or flow wire in various aspects. In some circumstances, thesystem 100 may include additional elements and / or may be implemented without one or more of the elements illustrated in Figure 1. For example, the system 100 may omit the external imaging system 132.

[0061] The intraluminal imaging system 100 (or intravascular imaging system) can be any type of imaging system suitable for use in the lumens or vasculature of a patient. In some aspects, the intraluminal imaging system 100 is an intravascular ultrasound (IVUS) imaging system. In other aspects, the intraluminal imaging system 100 may include systems configured for forward looking intravascular ultrasound (FL-IVUS) imaging, intravascular photoacoustic (IVPA) imaging, intracardiac echocardiography (ICE), transesophageal echocardiography (TEE), and / or other suitable imaging modalities.

[0062] It is understood that the system 100 and / or device 102 can be configured to obtain any suitable intraluminal imaging data. In some aspects, the device 102 may include an imaging component of any suitable imaging modality, such as optical imaging, optical coherence tomography (OCT), etc. In some aspects, the device 102 may include any suitable non-imaging component, including a pressure sensor, a flow sensor, a temperature sensor, an optical fiber, a reflector, a mirror, a prism, an ablation element, a radio frequency (RF) electrode, a conductor, or combinations thereof. Generally, the device 102 can include an imaging element to obtain intraluminal imaging data associated with the lumen 120. The device 102 may be sized and shaped (and / or configured) for insertion into a vessel or lumen 120 of the patient.

[0063] The system 100 may be deployed in a catheterization laboratory having a control room. The processing system 106 may be located in the control room. Optionally, the processing system 106 may be located elsewhere, such as in the catheterization laboratory itself. The catheterization laboratory may include a sterile field while its associated control room may or may not be sterile depending on the procedure to be performed and / or on the health care facility. The catheterization laboratory and control room may be used to perform any number of medical imaging procedures such as angiography, fluoroscopy, CT, IVUS, virtual histology (VH), forward looking IVUS (FL-IVUS), intraluminal photoacoustic (IVPA) imaging, a fractional flow reserve (FFR) determination, a coronary flow reserve (CFR) determination, optical coherence tomography (OCT), computed tomography, intracardiac echocardiography (ICE), forward-looking ICE (FLICE), intraluminal palpography, transesophageal ultrasound, fluoroscopy, and other medical imaging modalities, or combinations thereof. In some aspects,device 102 may be controlled from a remote location such as the control room, such than an operator is not required to be in close proximity to the patient.

[0064] The intraluminal device 102, PIM 104, monitor 108, and external imaging system 132 may be communicatively coupled directly or indirectly to the processing system 106. These elements may be communicatively coupled to the medical processing system 106 via a wired connection such as a standard copper link or a fiber optic link and / or via wireless connections using IEEE 802.11 Wi-Fi standards, Ultra Wide-Band (UWB) standards, wireless FireWire, wireless USB, or another high-speed wireless networking standard. The processing system 106 may be communicatively coupled to one or more data networks, e.g., a TCP / IP-based local area network (LAN). In other aspects, different protocols may be utilized such as Synchronous Optical Networking (SONET). In some cases, the processing system 106 may be communicatively coupled to a wide area network (WAN). The processing system 106 may utilize network connectivity to access various resources. For example, the processing system 106 may communicate with a Digital Imaging and Communications in Medicine (DICOM) system, a Picture Archiving and Communication System (PACS), and / or a Hospital Information System (HIS) via a network connection.

[0065] At a high level, an ultrasound imaging intraluminal device 102 emits ultrasonic energy from a transducer array 124 included in scanner assembly 110 mounted near a distal end of the intraluminal device 102. The ultrasonic energy is reflected by tissue structures in the medium (such as a lumen 120) surrounding the scanner assembly 110, and the ultrasound echo signals are received by the transducer array 124. The scanner assembly 110 generates electrical signal(s) representative of the ultrasound echoes. The scanner assembly 110 can include one or more single ultrasound transducers and / or a transducer array 124 in any suitable configuration, such as a planar array, a curved array, a circumferential array, an annular array, etc. For example, the scanner assembly 110 can be a one-dimensional array or a two-dimensional array in some instances. In some instances, the scanner assembly 110 can be a rotational ultrasound device. The active area of the scanner assembly 110 can include one or more transducer materials and / or one or more segments of ultrasound elements (e.g., one or more rows, one or more columns, and / or one or more orientations) that can be uniformly or independently controlled and activated. The active area of the scanner assembly 110 can be patterned or structured in various basic or complex geometries. The scanner assembly 110 can be disposed ina side-looking orientation (e.g., ultrasonic energy emitted perpendicular and / or orthogonal to the longitudinal axis of the intraluminal device 102) and / or a forward-looking looking orientation (e.g., ultrasonic energy emitted parallel to and / or along the longitudinal axis). In some instances, the scanner assembly 110 is structurally arranged to emit and / or receive ultrasonic energy at an oblique angle relative to the longitudinal axis, in a proximal or distal direction. In some aspects, ultrasonic energy emission can be electronically steered by selective triggering of one or more transducer elements of the scanner assembly 110.

[0066] The ultrasound transducer(s) of the scanner assembly 110 can be a piezoelectric micromachined ultrasound transducer (PMUT), capacitive micromachined ultrasonic transducer (CMUT), single crystal, lead zirconate titanate (PZT), PZT composite, other suitable transducer type, and / or combinations thereof. In an aspect the ultrasound transducer array 124 can include any suitable number of individual transducer elements or acoustic elements between 1 acoustic element and 1000 acoustic elements, including values such as 2 acoustic elements, 4 acoustic elements, 36 acoustic elements, 64 acoustic elements, 128 acoustic elements, 500 acoustic elements, 812 acoustic elements, and / or other values both larger and smaller.

[0067] The PIM 104 transfers the received echo signals to the processing system 106 where the ultrasound image (including the flow information) is reconstructed and displayed on the monitor 108. The console or processing system 106 can include a processor and a memory. The processing system 106 may be operable to facilitate the features of the intraluminal imaging system 100 described herein. For example, the processor can execute computer readable instructions stored on the non-transitory tangible computer readable medium.

[0068] The PIM 104 facilitates communication of signals between the processing system 106 and the scanner assembly 110 included in the intraluminal device 102. This communication may include providing commands to integrated circuit controller chip(s) within the intraluminal device 102, selecting particular element(s) on the transducer array 124 to be used for transmit and receive, providing the transmit trigger signals to the integrated circuit controller chip(s) to activate the transmitter circuitry to generate an electrical pulse to excite the selected transducer array element(s), and / or accepting amplified echo signals received from the selected transducer array element(s) via amplifiers included on the integrated circuit controller chip(s). In some aspects, the PIM 104 performs preliminary processing of the echo data prior to relaying the data to the processing system 106. In examples of such aspects, the PIM 104 performs amplification,filtering, and / or aggregating of the data. In an aspect, the PIM 104 also supplies high- and low- voltage DC power to support operation of the intraluminal device 102 including circuitry within the scanner assembly 110.

[0069] The processing system 106 receives echo data from the scanner assembly 110 by way of the PIM 104 and processes the data to reconstruct an image of the tissue structures in the medium surrounding the scanner assembly 110. Generally, the device 102 can be utilized within any suitable anatomy and / or body lumen of the patient. The processing system 106 outputs image data such that an image of the vessel or lumen 120, such as a cross-sectional IVUS image of the lumen 120, is displayed on the monitor 108. Lumen 120 may represent fluid filled or fluid-surrounded structures, both natural and man-made. Lumen 120 may be within a body of a patient. Lumen 120 may be a blood vessel, such as an artery or a vein of a patient’s vascular system, including cardiac vasculature, peripheral vasculature, neural vasculature, renal vasculature, and / or or any other suitable lumen inside the body. For example, the device 102 may be used to examine any number of anatomical locations and tissue types, including without limitation, organs including the liver, heart, kidneys, gall bladder, pancreas, lungs; ducts; intestines; nervous system structures including the brain, dural sac, spinal cord and peripheral nerves; the urinary tract; as well as valves within the blood, chambers or other parts of the heart, and / or other systems of the body. In addition to natural structures, the device 102 may be used to examine man-made structures such as, but without limitation, heart valves, stents, shunts, filters and other devices.

[0070] The controller or processing system 106 may include a processing circuit having one or more processors in communication with memory and / or other suitable tangible computer readable storage media. The controller or processing system 106 may be configured to carry out one or more aspects of the present disclosure. In some aspects, the processing system 106 and the monitor 108 are separate components. In other aspects, the processing system 106 and the monitor 108 are integrated in a single component. For example, the system 100 can include a touch screen device, including a housing having a touch screen display and a processor. The system 100 can include any suitable input device, such as a touch sensitive pad or touch screen display, keyboard / mouse, joystick, button, etc., for a user to select options shown on the monitor 108. The processing system 106, the monitor 108, the input device, and / or combinations thereof can be referenced as a controller of the system 100. The controller can be in communicationwith the device 102, the PIM 104, the processing system 106, the monitor 108, the input device, and / or other components of the system 100.

[0071] In some aspects, the intraluminal device 102 includes some features similar to traditional solid-state IVUS catheters, such those disclosed in U.S. Patent No. 7,846,101, hereby incorporated by reference in its entirety. For example, the intraluminal device 102 may include the scanner assembly 110 near a distal end of the intraluminal device 102 and a transmission line bundle 112 extending along the longitudinal body of the intraluminal device 102. The cable or transmission line bundle 112 can include a plurality of conductors, including one, two, three, four, five, six, seven, or more conductors.

[0072] The transmission line bundle 112 terminates in a PIM connector 114 at a proximal end of the intraluminal device 102. The PIM connector 114 electrically couples the transmission line bundle 112 to the PIM 104 and physically couples the intraluminal device 102 to the PIM 104. In an aspect, the intraluminal device 102 further includes a guidewire exit port 116. Accordingly, in some instances the intraluminal device 102 is a rapid-exchange catheter. The guide wire exit port 116 allows a guidewire 118 to be inserted towards the distal end in order to direct the intraluminal device 102 through the lumen 120.

[0073] The monitor 108 may be a display device such as a computer monitor or other type of screen. The monitor 108 may be used to display selectable prompts, instructions, and visualizations of imaging data to a user. In some aspects, the monitor 108 may be used to provide a procedure-specific workflow to a user to complete an intraluminal imaging procedure. This workflow may include performing a pre-stent plan to determine the state of a lumen and potential for a stent, as well as a post-stent inspection to determine the status of a stent that has been positioned in a lumen.

[0074] The external imaging system 132 can be configured to obtain x-ray, radiographic, angiographic / venographic (e.g., with contrast), and / or fluoroscopic (e.g., without contrast) images of the body of a patient (including the vessel 120). External imaging system 132 may also be configured to obtain computed tomography images of the body of the patient (including the vessel 120). The external imaging system 132 may include an external ultrasound probe configured to obtain ultrasound images of the body of the patient (including the vessel 120) while positioned outside the body. In some aspects, the system 100 includes other imaging modality systems (e.g., MRI) to obtain images of the body of the patient (including the vessel120). The processing system 106 can utilize the images of the body of the patient in conjunction with the intraluminal images obtained by the intraluminal device 102.

[0075] Figure 2 is a schematic diagram of a processor circuit 250, according to aspects of the present disclosure. The processor circuit 250 may be implemented in the intraluminal imaging system 100, or other devices or workstations (e.g., third-party workstations, network routers, etc.), or on a cloud processor or other remote processing unit, as necessary to implement the method. As shown, the processor circuit 250 may include a processor 260, a memory 264, and a communication module 268. These elements may be in direct or indirect communication with each other, for example via one or more buses.

[0076] The processor 260 may include a central processing unit (CPU), a digital signal processor (DSP), an ASIC, a controller, or any combination of general-purpose computing devices, reduced instruction set computing (RISC) devices, application-specific integrated circuits (ASICs), field programmable gate arrays (FPGAs), or other related logic devices, including mechanical and quantum computers. The processor 260 may also comprise another hardware device, a firmware device, or any combination thereof configured to perform the operations described herein. The processor 260 may also be implemented as a combination of computing devices, e.g., a combination of a DSP and a microprocessor, a plurality of microprocessors, one or more microprocessors in conjunction with a DSP core, or any other such configuration.

[0077] The memory 264 may include a cache memory (e.g., a cache memory of the processor 260), random access memory (RAM), magnetoresistive RAM (MRAM), read-only memory (ROM), programmable read-only memory (PROM), erasable programmable read only memory (EPROM), electrically erasable programmable read only memory (EEPROM), flash memory, solid state memory device, hard disk drives, other forms of volatile and non-volatile memory, or a combination of different types of memory. In an aspect, the memory 264 includes a non-transitory computer-readable medium. The memory 264 may store instructions 266. The instructions 266 may include instructions that, when executed by the processor 260, cause the processor 260 to perform the operations described herein. Instructions 266 may also be referred to as code. The terms “instructions” and “code” should be interpreted broadly to include any type of computer-readable statement(s). For example, the terms “instructions” and “code” may refer to one or more programs, routines, sub-routines, functions, procedures, etc. “Instructions”and “code” may include a single computer-readable statement or many computer-readable statements.

[0078] The communication module 268 can include any electronic circuitry and / or logic circuitry to facilitate direct or indirect communication of data between the processor circuit 250, and other processors or devices. In that regard, the communication module 268 can be an input / output (I / O) device. In some instances, the communication module 268 facilitates direct or indirect communication between various elements of the processor circuit 250 and / or the intraluminal imaging system 100. The communication module 268 may communicate within the processor circuit 250 through numerous methods or protocols. Serial communication protocols may include but are not limited to United States Serial Protocol Interface (US SPI), Inter- Integrated Circuit (I2C), Recommended Standard 232 (RS-232), RS-485, Controller Area Network (CAN), Ethernet, Aeronautical Radio, Incorporated 429 (ARINC 429), MODBUS, Military Standard 1553 (MIL-STD-1553), or any other suitable method or protocol. Parallel protocols include but are not limited to Industry Standard Architecture (ISA), Advanced Technology Attachment (ATA), Small Computer System Interface (SCSI), Peripheral Component Interconnect (PCI), Institute of Electrical and Electronics Engineers 488 (IEEE-488), IEEE-1284, and other suitable protocols. Where appropriate, serial and parallel communications may be bridged by a Universal Asynchronous Receiver Transmitter (UART), Universal Synchronous Receiver Transmitter (USART), or other appropriate subsystem.

[0079] External communication (including but not limited to software updates, firmware updates, preset sharing between the processor and central server, or readings from the annular ultrasound imaging array) may be accomplished using any suitable wireless or wired communication technology, such as a cable interface such as a universal serial bus (USB), micro USB, Lightning, or FireWire interface, Bluetooth, Wi-Fi, ZigBee, Li-Fi, or cellular data connections such as 2G / GSM (global system for mobiles) , 3G / UMTS (universal mobile telecommunications system), 4G, long term evolution (LTE), WiMax, or 5G. For example, a Bluetooth Low Energy (BLE) radio can be used to establish connectivity with a cloud service, for transmission of data, and for receipt of software patches. The controller may be configured to communicate with a remote server, or a local device such as a laptop, tablet, or handheld device, or may include a display capable of showing status variables and other information.Information may also be transferred on physical media such as a USB flash drive or memory stick.

[0080] It will also be understood that one or more of the steps of the methods described above can be performed by one or more components of an ultrasound imaging system, such as the processing system, a multiplexer, a beamformer, a signal processing unit, an image processing unit, or any other suitable component of the system. For example, activating the scan sequences may be carried out by a processor in communication with a multiplexer configured to select or activate one or more elements of an ultrasound transducer array. In some aspects, generating the ultrasound images may include beamforming incoming signals from the ultrasound imaging device and processing the beamformed signals by an image processor. The processing components of the system can be integrated within the ultrasound imaging device, contained within an external console, or may be a separate component.

[0081] Figure 3 illustrates a blood vessel 300 incorporating a plaque 330, according to aspects of the present disclosure. The plaque 330 occurs within the vessel walls 310 and may restrict the flow of blood 320 by reducing the area of the vessel lumen 315. The lumen 315 is defined by the lumen border, and the vessel well 310 is defined by the lumen border 360 and the vessel border 370.

[0082] In the example shown in Figure 3, the blood vessel includes relatively healthy segments 340 and a diseased segment 350. A distal reference frame or landing zone 344 is located in the healthy region 340 distal of the plaque 330, and has a lumen diameter 316 and a vessel diameter 372. A proximal reference frame or landing zone 346 is located in the healthy region 340 proximal of the plaque 330, and has a lumen diameter 318 and a vessel diameter 376. In between the proximal reference frame 346 and the distal reference frame 344 is a target frame 380, which may for example be the frame at which the minimum lumen area (MLA) occurs. The target frame 380 has a lumen diameter 317 and a vessel diameter 374.

[0083] At any given location along the vessel 300, the lumen has a cross-sectional area associated with the lumen diameter, and the vessel has a cross-sectional area associated with the vessel diameter. Each frame or location also has a plaque burden defined as:(Vessel Area - Lumen Area) / Vessel Area (EQN. 1)

[0084] In some cases, the definition of a diseased segment of a vessel may be any segment of the vessel in which the plaque burden exceeds 50% along the entire length of the segment. Thus, generally speaking, for a diseased vessel, the target frame will have a plaque burden of greater than 50% (and often greater than 70%), whereas the proximal and distal reference frames are selected (e.g., by an automated system) such that they have a plaque burden less than 50%, and may for example be the closest proximal and distal frames to the MLA that meet this criterion.

[0085] Figure 4 illustrates a blood vessel 300 incorporating a plaque 330 and with a stent 440 expanded inside it to restore flow, according to aspects of the present disclosure. The stent 440 displaces and arrests the plaque 330 by pushing the lumen border 360 and vessel border 370 outward, thus reducing the restriction of the blood flow 320. Other treatment options for alleviating a plaque or other occlusion may include but are not limited to thrombectomy, ablation, angioplasty, and pharmaceuticals.

[0086] The stent 440 has a diameter 415. The stent also has a proximal edge 446 that has been placed to coincide with the proximal landing zone 346, and a distal edge 444 that has been placed to coincide with the distal landing zone 344. Along the length of the stent 440, the vessel 300 conforms to the stent such that the lumen diameter is equal to the stent diameter 415 at the proximal landing zone 346, the target frame 380, and the distal reference frame 344, as well as at locations in between these points. Notably, the vessel diameters 472 and 476 at the distal and proximal references, respectively, may be larger than the vessel diameters 372 and 376 of Figure 3, and the vessel diameter 474 at the target frame (or former MLA) may be substantially larger than the vessel diameter 374 of Figure 3.

[0087] Figure 5 is a lesion length screen display 500 of an example stent placement planning system 510, according to aspects of the present disclosure. The screen display 500 may for example be generated by an IVI (e.g., IVUS or OCT) image analysis system configured to detect a diseased segment 520 within a vessel, and to automatically select the distal reference frame 544, target frame 580, and proximal reference frame 546 that define the diseased segment.

[0088] The lesion length screen display 500 includes a co-registered angiographic image 530, a graphical image longitudinal display (ILD) 540, and a tomographic image display area 550.

[0089] The angiographic image 530 shows an X-ray image of the blood vessel 300, annotated with a co-registered view of the diseased segment 520, along with its length 560. Theangiographic image 530 may for example be captured by the external imaging system 132 (see Figure 1) after a contrast agent has been injected into the patient’s bloodstream. The angiographic image 530 includes a marker indicating target frame 580.

[0090] The ILD 540 includes a stylized graphical view of the blood vessel 300, including a graphical representation of the lumen diameter or area and the vessel diameter or area of the blood vessel 300 at each location along the blood vessel 300. Locations of the distal reference frame 544, target frame 580, and proximal reference frame 546 are marked on the ILD 540, as is the length 560 of the diseased segment 520.

[0091] The tomographic image display area 550 includes tomographic or cross-sectional IVI (e.g., IVUS or OCT) images 554, 555, and 556 and numerical statistics 574, 575, and 576 of the distal reference frame 544, target frame 580, and proximal reference frame 546, respectively.

[0092] The screen display 500 is configured to show, at a glance, multiple types of information helpful for a clinician in understanding the length, position, and severity of the diseased segment 520 within the blood vessel 300. In the example shown in Figure 5, the length 560 of the diseased segment 520 is 10.9 millimeters, which may not correspond to the length of any available stent.

[0093] Figure 6 is a stent planning screen display 600 of an example stent placement planning system 510, according to aspects of the present disclosure. In the example shown in Figure 6, the proximal target frame or landing zone 546 has been moved to the right as compared with the proximal target frame or landing zone 546 of Figure 5, in order to change the length 560 of the segment to an integer number (e.g., 15 mm) that corresponds with the length of an available stent. This may be done for example by typing a new length value into the text box 610, or by grabbing the proximal handle 620 of the ILD or co-registered angiographic image and dragging it in a proximal direction. Similarly, dragging the proximal handle 620 in a distal direction can shorten the segment. There is also a distal handle 630 in both the ILD and the angiographic image that can be used to lengthen or shorten the segment by moving the distal reference frame or landing zone 544 in a proximal or distal direction. The angiographic image 530 includes a marker indicating target frame 580. The proximal image 556 and the corresponding statistics 576 change from Fig. 5 to Fig. 6 because of the change from the length of lesion / diseased segment 520 in Fig. 5 to the length of the virtual stent 560 in Fig. 6.

[0094] Once the length of the segment 520 has been adjusted to match the length of an available stent, the segment 520 may be considered a virtual stent 660. However, it is noted that in the example shown in Figure 6, the 15 mm virtual stent is not in a good placement, as the distal landing zone plaque burden 640 differs significantly different from the proximal landing zone plaque burden 650, and because the proximal landing zone plaque burden 650 is greater than 50%. Thus, a user may want to move the virtual stent 660 to a more favorable location, as shown below in Figures 7 and 8.

[0095] The shape of the markers indicating the target frame 580 and / or proximal and distal handles 620, 630 in the ILD or the angiographic image are exemplary. The shape can be lines, rectangles, circles, dotted, solid, etc., and / or combinations thereof. The shape can be positioned over and / or across the vessel (e.g., transversely). The shape of the markers indicating the target frame 580 and / or proximal and distal handles 620, 630 can be the same as one another or different from one another.

[0096] Figure 7 is a stent planning screen display 700 of an example stent placement planning system 510, according to aspects of the present disclosure. In the example shown in Figure 7, the user has used a pointer 710 (e.g., a mouse pointer with a click- and-drag input, or a touch screen with a touch-and-drag input) to grab the virtual stent 660 and drag it in a distal direction 720 from a first position to a second position. With the pointer 710, the user can grab and move the virtual stent in either the angiographic image 530 or the ILD 540. While the virtual stent is being moved, the proximal handles 620 and distal handles 640 in the angiographic image and the ILD may optionally change color or otherwise change appearance, to indicate that both the proximal landing zone 546 and the distal landing zone 544 are being moved simultaneously, and thus the virtual stent 660 is changing position but not changing size. The proximal and distal image frames 554 and 556, and the corresponding numerical statistics 574 and 576, have changed from Fig. 6 to 7 because these automatically update based on the current locations of the proximal landing zone 546 and the distal landing zone 544 while the virtual stent 660 is being moved. It is further noted that in the example shown in Figure 7, the 15 mm virtual stent is still not in a location where the distal plaque burden 640 and the proximal plaque burden 650 have similar values and are both less than 50%. Thus, it may be desirable to continue moving the virtual stent 660 until a second location is found that meets these criteria. The target location 580 did not move (and the target frame 555 and corresponding statistics 575 did notchange from Fig. 6 to Fig. 7) when the virtual stent 660 moved because the target location 580 is still positioned within proximal and distal ends of the virtual stent 660. In some instances, if the virtual stent 660 moves distally or proximally past the target location 580, then the processor circuit determines a new target location that is positioned within proximal and distal ends of the virtual stent 660 (e.g., a location between the proximal and distal ends of the virtual stent that has a minimum lumen area, minimum lumen area, a maximum plaque burden, etc., and / or combinations thereof).

[0097] Figure 8 is a stent planning screen display 800 of an example stent placement planning system 510, according to aspects of the present disclosure. In the example shown in Figure 8, the 15 mm virtual stent 660 has been moved to a second location where (1) the target frame 580 is between the distal landing zone 544 and the proximal landing zone 546, (2) the distal landing zone plaque burden 640 and the proximal landing zone plaque burden 650 are both less than 50%, and (3) the distal landing zone plaque burden 640 and the proximal landing zone plaque burden 650 have similar values to one another (e.g., within 2% of each other, within 1.5% of each other, etc.). Thus, the virtual stent 660 may be considered to be in a favorable placement. Thus, the annotated angiographic image 530 can now be used as a roadmap or stent placement plan 830, with the virtual stent 660 being shown in the desired location within the blood vessel 300. The proximal and distal image frames 554 and 556, and the corresponding numerical statistics 574 and 576, have changed from Fig. 7 to 8 because these automatically update to reflect the current location of the proximal landing zone 546 and the distal landing zone 544 of the virtual stent 660. The target location 555 did not move (and the target frame 555 and corresponding statistics 575 did not change) from Fig. 7 to Fig. 8.

[0098] Figure 9 is a stent planning screen display 900 of an example stent placement planning system 510, according to aspects of the present disclosure. In the example shown in Figure 8, the user has changed the length 560 of the stent from 15 mm to 12 mm, such that both the distal landing zone 544 and the proximal landing zone 546 have moved closer to the target frame 580 by approximately 1.5 mm. This can be accomplished for example by typing a new length value into the text box 610, or by moving both handles 620, 630 toward the target frame 580. In this position, the 12 mm virtual stent 660 still meets the criteria that (1) the target frame 580 is between the distal landing zone 544 and the proximal landing zone 546, (2) the distal landing zone plaque burden 640 and the proximal landing zone plaque burden 650 are both lessthan 50%, and (3) the distal landing zone plaque burden 640 and the proximal landing zone plaque burden 650 have similar values to one another. Thus, a 12 mm stent may be considered to be usable in place of a 15 mm stent, if desired, to treat the diseased segment of the blood vessel. The proximal and distal image frames 554 and 556, and the corresponding numerical statistics 574 and 576, have changed from Fig. 8 to 9 because of the change in the length of the virtual stent, as these automatically update to reflect the current location of the proximal landing zone 546 and the distal landing zone 544 of the virtual stent 660. The target location 555 did not move (and the target frame 555 and corresponding statistics 575 did not change) from Fig. 8 to Fig. 9 because the target location 555 is located within both the 15 mm virtual stent (Fig. 8) and the 12 mm virtual stent (Fig. 9).

[0099] Figure 10 is a stent planning screen display 1000 of an example stent placement planning system 510, according to aspects of the present disclosure. The screen display 1000 includes a roadmap or planning image 830, which is an angiographic image (e.g., an X-ray image with contrast dye injected into the patient’s bloodstream) of the blood vessel 300, overlaid with an image of the virtual stent 660, including the distal landing zone 544 and proximal landing zone 546. The screen display 1000 also includes a fluoroscopic image 1030 (e.g., a live X-ray image of the blood vessel 300 taken during the stent placement procedure, without contrast, such that the blood vessel 300 is not visible in the image). A delivery catheter 1010 is visible in the fluoroscopic image 1030, following the contours of the blood vessel 300. Near the distal end of the delivery catheter 1010 is a physical (e.g., non-virtual) stent 440, which is being delivered into the diseased portion of the blood vessel 300.

[0100] In an example, the roadmap or planning image 830 shows the virtual stent 660 in its desired location (e.g., a location meeting the criteria discussed above in Figures 8 and 9), and the clinician advances the delivery catheter 1010 until its contours indicate that the stent 440 is in the same location of the fluoroscopic image 1030 as the virtual stent 660 in the roadmap image or stent placement plan image 830. Once the stent 440 is in position, it can be expanded and left in place to treat the lesion, as shown for example in Figure 4. The delivery catheter 1010 can then be withdrawn from the vessel 300.

[0101] Figure 11 is a schematic, diagrammatic view, in flow diagram form, of an example stent planning method 1100, according to aspects of the present disclosure. It is understood that the steps of method 1100 may be performed in a different order than shown in Figure 11,additional steps can be provided before, during, and after the steps, and / or some of the steps described can be replaced or eliminated in other aspects. One or more of steps of the method 1100 can be carried by one or more devices and / or systems described herein, such as components of the system 510, processing system 106, and / or processor circuit 250.

[0102] In step 1105, the method 1100 includes controlling the intravascular imaging catheter to obtain intravascular images along the blood vessel while the intravascular imaging catheter is moved (e.g., pulled back) through the blood vessel. Execution then proceeds to step 1110.

[0103] In step 1110, the method 1100 includes identifying a diseased segment of the blood vessel (e.g., a segment containing a plaque or other lesion), by identifying a proximal reference frame, target frame, and distal reference frame. This may for example include calculating the lumen dimensions based on the lumen border and / or the lumen area. In that regard, aspects of the present disclosure can include features described in U.S. Publication No. 2007 / 0201736, U.S. Patent No. 11,272,845, U.S. Patent No. 7,463,759, U.S. Patent No. 9,295,447, U.S. Patent No. 11,744,527, U.S. Publication No. 2020 / 0029932, U.S. Publication No. 2019 / 0282211, each of which is hereby incorporated by reference as though fully set forth herein. Execution then proceeds to step 1115.

[0104] In step 1115, the method 1100 includes outputting a screen display that includes: 1) a visual representation of the vessel, with the identified lesion segment overlaid on the visual representation, and 2) intravascular images of the proximal reference frame, target frame, and distal reference frame. Execution then proceeds to step 1120.

[0105] In step 1120, the method 1100 includes receiving a user input to modify the length of the identified lesion segment to a first length (length #1), thus producing a virtual stent.Execution then proceeds to step 1125.

[0106] In step 1125, the method 1100 includes updating the screen display such that the virtual stent is overlaid at a first position on the visual representation of the vessel, and such that the intravascular images are of the proximal landing zone (first position), target frame, and distal landing zone (second position). Execution then proceeds to step 1130.

[0107] In step 1130, the method 1100 includes receiving a user input to move the virtual stent from the first position to a different, second position on the visual representation, without changing the length of the virtual stent. Execution then proceeds to step 1135.

[0108] In step 1135, the method 1100 includes updating the screen display such that the virtual stent is overlaid at the second position on the visual representation of the vessel, and such that the intravascular images are of the proximal landing zone (second position), target frame, and distal landing zone (second position). If the user is satisfied with the positioning of the stent, the screen display, or portions thereof, can now serve as a stent planning or roadmap display. Execution them proceeds to step 1140.

[0109] In step 1140, the method 1100 includes determining whether the user desires to change the virtual stent length. If yes, execution then proceeds to step 1145. If no, execution proceeds to step 1150.

[0110] In step 1145, the method 1100 includes receiving a user input to change the virtual stent length (e.g., to stent length #2, stent length #3, etc.). Execution then returns to step 1125.

[0111] In step 1150, the method 1100 includes performing stent placement based on the stent planning. Step 1150 includes substeps 1155 and 1160.

[0112] In substep 1155, the method 1100 includes outputting a roadmap image with the stent plan (e.g., an X-ray image of the vessel, with contrast, annotated with the virtual stent in the desired position), simultaneously with a live X-ray image stream, without contrast, of the vessel during the stent placement procedure. Execution then proceeds to substep 1160.

[0113] In step 1160 (performed by the clinician), the method 1100 includes deploying the stent at the stent plan location. The method 1100 is now complete.

[0114] It is noted that flow diagrams are provided herein for exemplary purposes; a person of ordinary skill in the art will recognize myriad variations that nonetheless fall within the scope of the present disclosure. For example, the logic of flow diagrams may be shown as sequential.However, similar logic could be parallel, massively parallel, object oriented, real-time, event- driven, cellular automaton, or otherwise, while accomplishing the same or similar functions. In order to perform the methods described herein, a processor may divide each of the steps described herein into a plurality of machine instructions, and may execute these instructions at the rate of several hundred, several thousand, several million, or several billion per second, in a single processor or across a plurality of processors. Such rapid execution may be necessary in order to execute the method in real time or near-real time as described herein. For example, moving the virtual stent in real time, in response to user inputs and with no perception of lag,may require updating the position of the virtual stent on the screen display at a frequency of at least 10 Hz, 20 Hz, 30 Hz, 40 Hz, 60 Hz, 120 Hz, and / or other values both larger and smaller .

[0115] Figure 12A is a close-up view of the ILD 540 from Figure 6, according to aspects of the present disclosure. In the example shown in Figure 12A, the virtual stent 660 is in a first location. Visible are the distal landing zone 544, target frame 580, and proximal landing zone 546, along with the proximal handle 620 that can be used to resize the virtual stent 660 by moving the proximal landing zone 546, and the distal handle 630 that can be used to resize the virtual stent 660 by moving the distal landing zone 544. By clicking and dragging on the virtual stent 660 itself, the user can move the virtual stent 660 without resizing it, by moving both the distal landing zone 544 and the proximal landing zone 546 in synchrony.

[0116] Figure 12B is a close-up view of the ILD from Figure 7, according to aspects of the present disclosure. In the example shown in Figure 12B, the virtual stent 660 is being moved in a distal direction 770 by a pointer 710. Depending on the implementation, the pointer may be used to move the virtual stent 660 by a mouse click-and-drag, a touchscreen touch-and drag, or other user input. Also visible are the distal landing zone 544, target frame 580, and proximal landing zone 546, along with the proximal handle 620 and distal handle 630, which are shown in a brighter color than in Figures 12A and 12C, to denote the fact that the virtual stent is moving.

[0117] Figure 12C is a close-up view of the ILD from Figure 8, according to aspects of the present disclosure. In the example shown in Figure 12C, the virtual stent 660 has been moved to a second location that is favorable for stent placement as described above in Figure 8. Visible are the distal landing zone 544, target frame 580, and proximal landing zone 546, along with the proximal handle 620 and distal handle 630.

[0118] Figure 13A is a close-up view of the tomographic image display area 550 from Figure 6, according to aspects of the present disclosure. In the example shown in Figure 13 A, the virtual stent is in a first location. Representing the distal landing zone are a tomographic image 554, annotated with the vessel border 1310 and lumen border 1320, as well as vessel metrics 574. Representing the target frame are a tomographic image 555 vessel border 1330, lumen border 1340, and vessel metrics 575. Representing the proximal landing zone are a tomographic image 556, vessel border 1350, lumen border 1360, and vessel metrics 576.

[0119] In the example shown in Figure 13 A, the distal landing zone plaque burden 640 is 43.5%, but the proximal landing zone plaque burden 650 is 72.8%, indicating that the first position is not suitable for stent placement.

[0120] Figure 13B is a close-up view of the tomographic image display area 550 from Figure 7, according to aspects of the present disclosure. In the example shown in Figure 13B, the virtual stent is in motion between a first location and a more distal second location. As a result, the frame number 1370 of the distal landing zone tomographic image 554 is decreasing as the virtual stent moves, and the frame number 1390 of the proximal landing zone tomographic image 556 is decreasing at the same rate, such that the size of the virtual stent does not change. The frame number of the target frame 1380 does not change while the virtual stent is moved, as the target frame represents the minimum lumen area (MLA), which is an anatomical feature of the blood vessel. Notably, while the distal landing zone plaque burden 640 is just 39.4%, the proximal landing zone plaque burden 650 is 53.6%, indicating that the virtual stent has not yet arrived at a suitable location as described above.

[0121] Figure 13C is a close-up view of the tomographic image display area 550 from Figure 8, according to aspects of the present disclosure. In the example shown in Figure 13C, the virtual stent has been moved from the first location to the more distal second location, and has stopped moving. As a result, the frame number 1370 of the distal landing zone tomographic image 554 is lower than in Figures 13 A and 13B, and the frame number 1390 of the proximal landing zone tomographic image 556 is by the same amount, such that the size of the virtual stent has not changed. Notably, the distal landing zone plaque burden 640 is 46.1%, and the proximal landing zone plaque burden 650 is 45.0%, indicating that the virtual stent has arrived at a suitable location as described above.

[0122] Figure 14A is a close-up view of the annotated angiographic image 530 of Figure 6, showing the 15 mm virtual stent 660 in the first position within the blood vessel 300, according to aspects of the present disclosure. Also visible are the target frame 580, along with the proximal handle 620 and distal handle 630, either of which can be grabbed (e.g., clicked-and- dragged, touched-and-dragged, etc.) and moved in order to resize the virtual stent. Grabbing and dragging any other portion of the virtual stent 660 allows the user to move the virtual stent proximally or distally within the blood vessel 300.

[0123] Figure 14B is a close-up view of the annotated angiographic image 530 of Figure 7, showing the 15 mm virtual stent 660 being moved within the blood vessel 300 in a distal direction 720, according to aspects of the present disclosure. A pointer 710 has grabbed the virtual stent 660, and the handles 620, 630 have changed color to signify the fact that the virtual stent 660 is being moved. Other visual indicators of movement may be used instead or in addition.

[0124] Figure 14C is a close-up view of the annotated angiographic image 530 of Figure 8, showing the 15 mm virtual stent 660 in the second (more distal) position within the blood vessel 300, according to aspects of the present disclosure. Also visible are the target frame 580, along with the proximal handle 620 and distal handle 630, which have reverted to their original color now that the virtual stent is no longer moving. The target location 580 did not move when the virtual stent 660 moved because the target location 580 is still positioned within proximal and distal ends of the virtual stent 660.

[0125] Figure 15 is a screen display 1500 of an example stent placement planning system 510, according to aspects of the present disclosure. In the example shown in Figure 15, the coregistered angiographic image is not shown, the vessel and lumen borders are not shown in the tomographic images 554, 555, and 556, and the ILD 540 is an image-based ILD (e.g., constructed from the IVI images) rather than a graphical ILD. The screen display 1500 otherwise retains the same or similar functionality to other screen displays shown above. For example, the user can still grab and move the virtual stent 660 or vessel segment 520 without changing its length.

[0126] Figure 16 is a screen display 1600 of an example stent placement planning system 510, according to aspects of the present disclosure. In the example shown in Figure 16, the vessel metrics are not shown. However, the length 560 of the virtual stent 660 or vessel segment 520 is still shown. The length is a distance measurement that relies on a known distance between images within the IVI pullback. This may be accomplished for example by pulling back the imaging catheter at a known speed (e.g., with a pullback device or sled), or by estimating the speed of the pullback or the distance between successive frames based on the anatomy of the blood vessel. The screen display 1600 otherwise retains the same or similar functionality to other screen displays shown above. For example, the user can still grab and move the virtual stent 660 or vessel segment 520 without changing its length.

[0127] Figure 17 is a screen display 1700 of an example stent placement planning system 510, according to aspects of the present disclosure. Figure 17 is similar to Figure 16, except that the distance measurement has also been removed. This represents a highly simplified visualization of the stent placement planning system 510, wherein the user can still grab and move the virtual stent 660 or vessel segment 520 without changing its length, but much of the associated information is not displayed.

[0128] Figure 18 is a screen display 1800 of an example stent placement planning system 510, according to aspects of the present disclosure. In the example shown in Figure 18, the user is in the midst of resizing the virtual stent 660 (e.g., from 12 mm to 15 mm, passing transiently through a value of 13.1 mm). A pointer 710 has grabbed the proximal handle 620 in the angiographic image 530 and the ILD 540 in order to move the proximal reference frame or landing zone 546, without moving the distal reference frame or landing zone 544. The proximal handle has changed color vs the proximal handle 630 in both the angiographic image 530 and the ILD 540 to denote the fact that the proximal reference frame or landing zone is moving.

[0129] Figure 19 is a screen display 1900 of an example stent placement planning system 510, according to aspects of the present disclosure. In the example shown in Figure 19, the user has clicked on the proximal reference tomographic image 556. This has changed the display screen in several ways. First, a scrubber 1910 has moved to the location of the proximal image frame 546 in both the co-registered angiographic image 530 and the ILD 540. Second, the proximal reference tomographic image 556 has become larger, and the target and distal reference tomographic images have disappeared. The vessel segment 520 or virtual stent 660 can still be seen in the ILD and the angiographic image, but is no longer highlighted, to denote the fact that it is not currently being viewed.

[0130] Figure 20 is a screen display 2000 of an example stent placement planning system 510, according to aspects of the present disclosure. In the example shown in Figure 20, the user is using a pointer 710 to click and drag the scrubber 1910 to a frame located inside the vessel segment 520 or virtual stent 660. As the scrubber moves proximally or distally, the frame number 2010 and tomographic image 2020 change to represent different frames in the I VI pullback sequence. This can be useful for example so that a clinician can examine the entire length of a diseased segment to obtain a better understanding of the vessel geometry.

[0131] Figure 21 is a screen display 2100 of an example stent placement planning system 510, according to aspects of the present disclosure. In the example shown in Figure 21, both the diseased vessel segment 520 and the virtual stent 660 are visible at the same time, in both the angiographic image 530 and the ILD 540. This can be useful for example so that the clinician can verify that the diseased segment falls entirely within the virtual stent, and so that the clinician can better understand the context for stent placement decisions. This also allows the user to move or resize the virtual stent 660 without affecting the size or position of the vessel segment 520.

[0132] Accordingly, it can be seen that the stent placement planning system advantageously permits the users of intraluminal imaging systems to determine the appropriate size and landing zones for a stent, with enhanced speed, accuracy, and repeatability. This technology can be applied to other types of ultrasound devices besides IVUS, including but not limited to 2D or 3D external ultrasound, trans -esophageal echography (TEE), or intracardiac echography (ICE), as well as optoacoustic or photoacoustic imaging technologies such as optical coherence tomography (OCT). The technology can be used in either or both of veins and arteries, including coronary arteries. The stent placement planning system’s workflow with the GUI interface may be highly visible. This technology could be applied to percutaneous coronary intervention or peripheral endovascular intervention, and may be useful not only for stent planning but for planning and deployment of other therapies used in these types of interventional procedures. For example, any type of angioplasty device, atherectomy device, or drug delivery device of a known length could potentially benefit from this type of IVI planning software.

[0133] A system of one or more computers can be configured to perform particular operations or actions by virtue of having software, firmware, hardware, or a combination of them installed on the system that in operation causes or cause the system to perform the actions. One or more computer programs can be configured to perform particular operations or actions by virtue of including instructions that, when executed by data processing apparatus, cause the apparatus to perform the actions.

[0134] One general aspect includes a system including a processor circuit configured for communication with an intravascular imaging catheter, where the processor circuit is configured to: control the intravascular imaging catheter to obtain a plurality of intravascular images while the intravascular imaging catheter is moved through a blood vessel of a patient; output a screendisplay for stent planning, where the screen display may include: a visual representation of the blood vessel; a virtual stent overlaid in a first position on the visual representation, where the virtual stent may include a proximal end, a distal end, and a length extending between the proximal end and the distal end; receive first user input to move the virtual stent from the first position to a different, second position on the visual representation; and update the screen display in response on the first user input such that the screen display may include: the visual representation of the blood vessel: the virtual stent overlaid in the second position on the visual representation, where the first user input does not change the length of the virtual stent such that the length of the virtual stent is the same: in the first position; in the second position; and while the virtual stent moves from the first position to the second position. Other related aspects include corresponding computer systems, apparatus, and computer programs recorded on one or more computer storage devices, each configured to perform the actions of the methods.

[0135] One general aspect includes a system including a processor circuit configured for communication with an intravascular imaging catheter, wherein the processor circuit is configured to: control the intravascular imaging catheter to obtain a plurality of intravascular images while the intravascular imaging catheter is moved through a blood vessel of a patient; output a screen display for stent planning, wherein the screen display comprises: a visual representation of the blood vessel; and a virtual stent overlaid in a first position on the visual representation; receive first user input to move the virtual stent from the first position to a different, second position on the visual representation, wherein the first user input does not change a length of the virtual stent; and update the screen display in response on the first user input such that the screen display comprises the virtual stent overlaid in the second position on the visual representation.

[0136] Implementations may include one or more of the following features. In some aspects, the length of the virtual stent is the same: in the first position; in the second position; and while the virtual stent moves from the first position to the second position. In some aspects, the processor circuit is configured to receive a second user input to change a lesion segment overlaid on the visual representation to the virtual stent. In some aspects, the second user input may include a first value of the length of the virtual stent. In some aspects, the length of the virtual stent is different than a length of the lesion segment. In some aspects, the length of the stent may include only integer values, and the length of the lesion segment may include non-integer valuesand the integer values. In some aspects, the length of the virtual stent may include a first value, and where the processor circuit is configured to: receive a third user input to change the length of the virtual stent to be a different, second value; and repeat the receiving the first user input and the updating the screen display in response to the first user input with the second value of the length of the virtual stent. In some aspects, the virtual stent comprises a proximal end and a distal end, and the length of the virtual stent extends between the proximal end and the distal end. In some aspects, the first user input received on the virtual stent between the proximal end and the distal end of the virtual stent. In some aspects, the processor circuit is configured to update the screen display such that a visual appearance of the proximal end and the distal end of the virtual stent is changed while the first user input is being received. In some aspects, the processor circuit is configured to receive a fourth user input to change a length of the virtual stent, where the fourth user input is received on the proximal end or the distal end of the virtual stent. In some aspects, when the fourth user input is received on the proximal end of the virtual stent, the processor circuit is configured to update the screen display such that a visual appearance of the proximal end of the virtual stent is changed while the fourth user input is being received, where, when the fourth user input is received on the distal end of the virtual stent, the processor circuit is configured to update the screen display such that a visual appearance of the distal end of virtual stent is changed while the fourth user input is being received. In some aspects, the screen display may include: a first area associated with a proximal landing zone of the virtual stent and may include one of the plurality of intravascular images corresponding to the proximal end of the virtual stent; and a second area associated with a distal landing of the virtual stent and may include one of the plurality of intravascular images corresponding to the proximal end of the virtual stent. In some aspects, the first area and the second area change based on a current position of the virtual stent while the virtual stent moves from the first position to the second position. In some aspects, the first area may include a first value of a metric associated with at least one of the blood vessel or a lumen of the blood vessel, where the second area may include a second value of the metric associated with at least one of the blood vessel or the lumen of the blood vessel. In some aspects, the first value of the metric and the second value of the metric change based on a current position of the virtual stent while the virtual stent moves from the first position to the second position. In some aspects, the plurality of intravascular images may include a first intravascular image, a second intravascular image, athird intravascular image, and a fourth intravascular image, where, before the first user input is received, the screen display may include: the first intravascular image, where the first intravascular depicts a first location of the blood vessel corresponding to the proximal end of the virtual stent in the first position, the second intravascular image, where the second intravascular image depicts a second location of the blood vessel corresponding to the distal end of the virtual stent in the first position where processor circuit is configured to update the screen display in response to the first user input such that the screen display may include: the third intravascular image, where the third intravascular image depicts a third location of the blood vessel corresponding to the proximal end of the virtual stent in the second position, the fourth intravascular image, where the fourth intravascular image depicts a fourth location of the blood vessel corresponding to the distal end of the virtual stent in the second position. In some aspects, before the first user input is received, the screen display may include: a first value of a metric associated with at least one of the blood vessel or a lumen of the blood vessel, where the first value is representative a first location of the blood vessel corresponding to the proximal end of the virtual stent in the first position, a second value of the metric representative of a second location of the blood vessel corresponding to the distal end of the virtual stent in the first position, where processor circuit is configured to update the screen display in response to the first user input such that the screen display may include: a third value of the metric representative of a third location of the blood vessel corresponding to the proximal end of the virtual stent in the second position, a fourth value of the metric representative of a fourth location of the blood vessel corresponding to the distal end of the virtual stent in the second position. In some aspects, the visual representation of the blood vessel may include at least one of: a longitudinal view of the vessel based on the plurality of intravascular images; or an x-ray image of the vessel. Implementations of the described techniques may include hardware, a method or process, or computer software on a computer-accessible medium.

[0137] One general aspect includes a system including a processor circuit configured for communication with an intravascular imaging catheter, where the processor circuit is configured to: control the intravascular imaging catheter to obtain a plurality of intravascular images while the intravascular imaging catheter is moved through a blood vessel of a patient, where the plurality of intravascular images may include first intravascular image, a second intravascular image, a third intravascular image, and a fourth intravascular image; output a screen display mayinclude: a visual representation of the blood vessel: a vessel segment indicator overlaid on the visual representation in a first position, where the vessel segment indicator may include a proximal end, a distal end, and a length extending between the proximal end and the distal end; the first intravascular image, where the first intravascular image is associated with the proximal end of the vessel segment indicator in the first position; and the second intravascular image, where the second intravascular image is associated with the distal end of the vessel segment indicator in the first position; receive a first user input to move the vessel segment indicator from the first position to a different second position; update the screen display in response to the user input such that the screen display may include: the visual representation of the vessel; the vessel segment indicator overlaid on the visual representation in the second position, where the length of the vessel segment indicator does not change in response to the user input; the third intravascular image, where the third intravascular image is associated with the proximal end of the vessel segment indicator in the second position; and the fourth intravascular image, where the fourth intravascular image is associated with the distal end of the vessel segment indicator in the second position. The first intravascular image changes to the third intravascular image simultaneously as the second intravascular image changes to the fourth intravascular image. Other related aspects include corresponding computer systems, apparatus, and computer programs recorded on one or more computer storage devices, each configured to perform the actions of the methods.

[0138] One general aspect includes system, comprising: a processor circuit configured for communication with an intravascular imaging catheter, wherein the processor circuit is configured to: control the intravascular imaging catheter to obtain a plurality of intravascular images while the intravascular imaging catheter is moved through a blood vessel of a patient; output a screen display comprising: a vessel segment indicator overlaid on a visual representation in a first position, wherein the vessel segment indicator comprises a proximal end and a distal end; and a first intravascular image and a second intravascular image respectively associated with the proximal end and the distal end of the vessel segment indicator in the first position; and receive a user input to move the vessel segment indicator from the first position to a different second position; update the screen display in response to the user input such that the screen display comprises: the vessel segment indicator overlaid on the visual representation in the second position; and a third intravascular image and a fourth intravascular image respectivelyassociated with the proximal end and the distal end of the vessel segment indicator in the second position, wherein the first intravascular image changes to the third intravascular image simultaneously as the second intravascular image changes to the fourth intravascular image.

[0139] Implementations may include one or more of the following features. In some aspects, the vessel segment indicator comprises a length between the proximal end and the distal end, and the user input does not change the length of the vessel segment indicator.

[0140] One general aspect includes a system that includes an intravascular imaging catheter; and a processor circuit configured for communication with the intravascular imaging catheter, where the processor circuit is configured to: control the intravascular imaging catheter to obtain a plurality of intravascular images depicting a plurality of locations along a blood vessel of a patient while the intravascular imaging catheter is moved through the blood vessel, where the plurality of intravascular images may include a first intravascular image, a second intravascular image, a third intravascular image, and a fourth intravascular image; output a screen display for stent planning, where the screen display may include: a visual representation of the blood vessel; a virtual stent overlaid in a first position on the visual representation, where the virtual stent may include a proximal end, a distal end, and a length extending between the proximal end and the distal end; a first area associated with a proximal landing zone of the virtual stent, where the first area may include the first intravascular image, where the first intravascular image depicts a first location of the blood vessel corresponding to the proximal end of the virtual stent in the first position; a second area associated with a distal landing zone of the virtual stent, where the second area may include the second intravascular image, where the second intravascular image depicts a second location of the blood vessel corresponding to the distal end of the virtual stent in the first position: receive user input to move the virtual stent from the first position to a different, second position on the visual representation; update the screen display in response on the user input such that the screen display may include: the visual representation of the blood vessel; the virtual stent overlaid in the second position on the visual representation, where the user input does not change the length of the virtual stent; the first area may include the third intravascular image, where the third intravascular image depicts a third location of the blood vessel corresponding to the proximal end of the virtual stent in the second position; and the second area may include the fourth intravascular image, where the fourth intravascular image depicts a fourth location of the blood vessel corresponding to the distal end of the virtual stent in the secondposition. Other related aspects include corresponding computer systems, apparatus, and computer programs recorded on one or more computer storage devices, each configured to perform the actions of the methods.

[0141] The logical operations making up the aspects of the technology described herein are referred to variously as operations, steps, objects, elements, components, modules, etc. Furthermore, it should be understood that these may occur or be performed or arranged in any order, unless explicitly claimed otherwise or a specific order is inherently necessitated by the claim language.

[0142] All directional references e.g., upper, lower, inner, outer, upward, downward, left, right, lateral, front, back, top, bottom, above, below, vertical, horizontal, clockwise, counterclockwise, proximal, and distal are only used for identification purposes to aid the reader’s understanding of the claimed subject matter, and do not create limitations, particularly as to the position, orientation, or use of the stent placement planning system. Connection references, e.g., attached, coupled, connected, joined, or “in communication with” are to be construed broadly and may include intermediate members between a collection of elements and relative movement between elements unless otherwise indicated. As such, connection references do not necessarily imply that two elements are directly connected and in fixed relation to each other. The term “or” shall be interpreted to mean “and / or” rather than “exclusive or.” The word “comprising” does not exclude other elements or steps, and the indefinite article “a” or “an” does not exclude a plurality. Unless otherwise noted in the claims, stated values shall be interpreted as illustrative only and shall not be taken to be limiting.

[0143] The above specification, examples and data provide a complete description of the structure and use of exemplary aspects of the stent placement planning system as defined in the claims. Although various aspects of the claimed subject matter have been described above with a certain degree of particularity, or with reference to one or more individual aspects, those skilled in the art could make numerous alterations to the disclosed aspects without departing from the spirit or scope of the claimed subject matter.

[0144] Still other aspects are contemplated. It is intended that all matter contained in the above description and shown in the accompanying drawings shall be interpreted as illustrative only of particular aspects and not limiting. Changes in detail or structure may be made without departing from the basic elements of the subject matter as defined in the following claims.

Claims

CLAIMSWhat is claimed is:

1. A system, comprising: a processor circuit configured for communication with an intravascular imaging catheter, wherein the processor circuit is configured to: control the intravascular imaging catheter to obtain a plurality of intravascular images while the intravascular imaging catheter is moved through a blood vessel of a patient; output a screen display for stent planning, wherein the screen display comprises: a visual representation of the blood vessel; and a virtual stent overlaid in a first position on the visual representation; receive first user input to move the virtual stent from the first position to a different, second position on the visual representation, wherein the first user input does not change a length of the virtual stent; and update the screen display in response on the first user input such that the screen display comprises the virtual stent overlaid in the second position on the visual representation.

2. The system of claim 1, wherein the length of the virtual stent is the same: in the first position; in the second position; and while the virtual stent moves from the first position to the second position.

3. The system of claim 1, wherein the processor circuit is configured to receive a second user input to change a lesion segment overlaid on the visual representation to the virtual stent.

4. The system of claim 3, wherein the second user input comprises a first value of the length of the virtual stent.

5. The system of claim 3, wherein the length of the virtual stent is different than a length of the lesion segment.

6. The system of claim 5, wherein the length of the stent comprises only integer values, and wherein the length of the lesion segment comprises non-integer values and the integer values.

7. The system of claim 1, wherein the length of the virtual stent comprises a first value, and wherein the processor circuit is configured to: receive a third user input to change the length of the virtual stent to be a different, second value; and repeat the receiving the first user input and the updating the screen display in response to the first user input with the second value of the length of the virtual stent.

8. The system of claim 1, wherein the virtual stent comprises a proximal end and a distal end, and wherein the length of the virtual stent extends between the proximal end and the distal end.

9. The system of claim 8, wherein the first user input is received on the virtual stent between the proximal end and the distal end of the virtual stent.

10. The system of claim 9, wherein the processor circuit is configured to update the screen display such that a visual appearance of the proximal end and the distal end of the virtual stent is changed while the first user input is being received.

11. The system of claim 8, wherein the processor circuit is configured to receive a fourth user input to change the length of the virtual stent,wherein the fourth user input is received on the proximal end or the distal end of the virtual stent.

12. The system of claim 11, wherein, when the fourth user input is received on the proximal end of the virtual stent, the processor circuit is configured to update the screen display such that a visual appearance of the proximal end of the virtual stent is changed while the fourth user input is being received, wherein, when the fourth user input is received on the distal end of the virtual stent, the processor circuit is configured to update the screen display such that a visual appearance of the distal end of virtual stent is changed while the fourth user input is being received.

13. The system of claim 8, wherein the screen display comprises: a first area associated with a proximal landing zone of the virtual stent and comprises one of the plurality of intravascular images corresponding to the proximal end of the virtual stent; and a second area associated with a distal landing of the virtual stent and comprises one of the plurality of intravascular images corresponding to the proximal end of the virtual stent.

14. The system of claim 13, wherein the first area and the second area change based on a current position of the virtual stent while the virtual stent moves from the first position to the second position.

15. The system of claim 13, wherein the first area comprises a first value of a metric associated with at least one of the blood vessel or a lumen of the blood vessel, wherein the second area comprises a second value of the metric associated with at least one of the blood vessel or the lumen of the blood vessel.

16. The system of claim 15, wherein the first value of the metric and the second value of the metric change based on a current position of the virtual stent while the virtual stent moves from the first position to the second position.

17. The system of claim 8, wherein the plurality of intravascular images comprises a first intravascular image, a second intravascular image, a third intravascular image, and a fourth intravascular image, wherein, before the first user input is received, the screen display comprises: the first intravascular image, wherein the first intravascular depicts a first location of the blood vessel corresponding to the proximal end of the virtual stent in the first position, the second intravascular image, wherein the second intravascular image depicts a second location of the blood vessel corresponding to the distal end of the virtual stent in the first position wherein processor circuit is configured to update the screen display in response to the first user input such that the screen display comprises: the third intravascular image, wherein the third intravascular image depicts a third location of the blood vessel corresponding to the proximal end of the virtual stent in the second position, the fourth intravascular image, wherein the fourth intravascular image depicts a fourth location of the blood vessel corresponding to the distal end of the virtual stent in the second position.

18. The system of claim 8, wherein, before the first user input is received, the screen display comprises: a first value of a metric associated with at least one of the blood vessel or a lumen of the blood vessel, wherein the first value is representative a first location of the blood vessel corresponding to the proximal end of the virtual stent in the first position, a second value of the metric representative of a second location of the blood vessel corresponding to the distal end of the virtual stent in the first position, wherein processor circuit is configured to update the screen display in response to the first user input such that the screen display comprises: a third value of the metric representative of a third location of the blood vessel corresponding to the proximal end of the virtual stent in the second position,a fourth value of the metric representative of a fourth location of the blood vessel corresponding to the distal end of the virtual stent in the second position.

19. The system of claim 1, wherein the visual representation of the blood vessel comprises at least one of: a longitudinal view of the vessel based on the plurality of intravascular images; or an x-ray image of the vessel.

20. A system, comprising: a processor circuit configured for communication with an intravascular imaging catheter, wherein the processor circuit is configured to: control the intravascular imaging catheter to obtain a plurality of intravascular images while the intravascular imaging catheter is moved through a blood vessel of a patient; output a screen display comprising: a vessel segment indicator overlaid on a visual representation in a first position, wherein the vessel segment indicator comprises a proximal end and a distal end; and a first intravascular image and a second intravascular image respectively associated with the proximal end and the distal end of the vessel segment indicator in the first position; and receive a user input to move the vessel segment indicator from the first position to a different second position; update the screen display in response to the user input such that the screen display comprises: the vessel segment indicator overlaid on the visual representation in the second position; and a third intravascular image and a fourth intravascular image respectively associated with the proximal end and the distal end of the vessel segment indicator in the second position,wherein the first intravascular image changes to the third intravascular image simultaneously as the second intravascular image changes to the fourth intravascular image.

21. The system of claim 20, wherein the vessel segment indicator comprises a length between the proximal end and the distal end, and wherein the user input does not change the length of the vessel segment indicator.

22. A system, comprising: an intravascular imaging catheter; and a processor circuit configured for communication with the intravascular imaging catheter, wherein the processor circuit is configured to: control the intravascular imaging catheter to obtain a plurality of intravascular images depicting a plurality of locations along a blood vessel of a patient while the intravascular imaging catheter is moved through the blood vessel, wherein the plurality of intravascular images comprises a first intravascular image, a second intravascular image, a third intravascular image, and a fourth intravascular image; output a screen display for stent planning, wherein the screen display comprises: a visual representation of the blood vessel; a virtual stent overlaid in a first position on the visual representation, where the virtual stent comprises a proximal end, a distal end, and a length extending between the proximal end and the distal end; a first area associated with a proximal landing zone of the virtual stent, wherein the first area comprises the first intravascular image, wherein the first intravascular image depicts a first location of the blood vessel corresponding to the proximal end of the virtual stent in the first position; a second area associated with a distal landing zone of the virtual stent, wherein the second area comprises the second intravascular image, wherein the second intravascular image depicts a second location of the blood vessel corresponding to the distal end of the virtual stent in the first position:receive user input to move the virtual stent from the first position to a different, second position on the visual representation; update the screen display in response on the user input such that the screen display comprises: the visual representation of the blood vessel; the virtual stent overlaid in the second position on the visual representation, wherein the user input does not change the length of the virtual stent; the first area comprises the third intravascular image, wherein the third intravascular image depicts a third location of the blood vessel corresponding to the proximal end of the virtual stent in the second position; and the second area comprises the fourth intravascular image, wherein the fourth intravascular image depicts a fourth location of the blood vessel corresponding to the distal end of the virtual stent in the second position.

Images